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Did you Ever Hear of a Good Death?

"Our dying and grieving processes have been disrupted during COVID"

I have to be honest; I had to read this article three times. I think back to March of 2020 and the "official" beginning of Covid-19 to everything that has happened in the world since it feels like we have had a dark cloud over our heads. We have a significant mental health crisis, and many are still suffering today from grief, sadness, anxiety, PTSD, and depression, particularly those that have experienced the loss of a loved one to Covid-19.

To me, it has been like watching a movie, except non of us were acting. or volunteered for the role. For months the streets of New York City were empty but for the homeless, police officers, and EMTs. Transit options were cut in half.

The New York "pause" on non-essential services, gatherings, and most non-essential retailers were closed from March 20 through April 29. Social distancing became the norm with daily death, and hospitalization counts were on tv every morning. Schools had to learn how to continue educating our youth remotely, and parents had to work additional roles, including teacher and IT tech, and find a way to balance their jobs while helping their children zoom into their classrooms from laptops. Any business where many people would gather indoors was closed. For example, restaurants could only stay open for take-out. Barber shops, sports arenas, schools, gyms, casinos, movie theatres, etc., all closed.

If you are reading this, you lived through it, and I'm sure you have your own experiences. While our leaders tried to do as much as they could as quickly as possible, we were not prepared for a pandemic. There was no contingency plan; if you remember, in the early days, you saw healthcare providers wearing garbage bags as PPE because there was not enough to go around. The restrictions were so strict there was yellow caution tape on playgrounds, and police officers made sure groups did not gather at the local basketball hoop.

On May 17th 2022 the United States surpassed one million deaths from Covid-19; a grim milestone that many in the healthcare community insist was hit well before May of 2022. In contrast, some argue the fact that this number is inflated because it was made clear in the beginning if you were hospitalized for say diabetes or cancer and happen to get infected while in the hospital, the cause of death on your death certificate was Covid-19 and not the preexisting condition that brought you to the hospital.

Any loss of life is devastating, but what makes death from Covid-19 different and possibly more painful?

There are a couple of reasons. The first is it is unexpected. Never in my lifetime did I think

co-morbidities I would live through a pandemic. While many that died of Covid-19 may have had co morbidities, many otherwise healthy people died from the virus and the virus alone.

Tasks of Dying

"Charles Corr, Ph.D., proposed that a good death is one in which four key tasks or needs have been fulfilled: physical, psychological, social, and spiritual. Physical needs include absence of pain or discomfort, and I would argue provides opportunity for human touch. Psychological needs include minimal fear or anxiety and increased emotional support. Social tasks often include opportunities to say goodbye, make amends, and enough human connection to feel engaged (social reciprocity). Spiritual needs could include meaning-making of one's life and death, and opportunities for forgiveness. In the context of dying during a pandemic, many of those tasks were unable to be satisfied.

With the lack of "good" deaths, it is unsurprising that the losses feel so traumatic -- they were traumatic. And traumatic losses place survivors at an increased risk for complicated or prolonged grief disorder. There are numerous risk factors, some inherent to the one grieving, but others specific to the nature of the death: Was the death untimely? Was the death unexpected? Was the death painful? Was the death preventable?

In many deaths during or due to COVID-19, the answers to the above questions are an irrevocable and unequivocally resounding: yes.

Even when considering deaths among older adults, many individuals were otherwise functional, and there was the promise of more years to be lived. That is partly why families may feel robbed; without the pandemic, their loved one would potentially be here today."

Another part that makes losing one to Covid-19 more traumatic is because you as a family member or as the patient really had no control over your treatment options. This was a moving target and every day doctors, the media and politicians updated us with information that changed by the minute and it was very difficult to understand who was right and who you should listen to.

You will remember in the beginning, when PPE was scarce, we were told that only healthcare workers should be wearing masks. On April 3, 2020, the CDC required non-medical face masks to be worn in public to reduce transmission, and this has changed by state many times since.

Because Covid-19 was seen as highly transmitttable, if you had a loved one in a hospital or nursing home there was no visitation. Visitation bans created a unbearable vacuum of information, control, loneliness, hopelessness and depression.
For over a year, families could not sit by the bedside during their loved one's final days and moments due to pandemic protocols. This was true for all patients even if they were not being hospitalized for Covid-19.

Instead, families of the sick had to wait for a call from a nurse to say goodbye via facetime or be told that their loved one had passed away. buriedThe same was true for nursing home residents. Because of the higher risk to the geriatric population, many nursing homes had no visitation protocols as well. This caused terrible strain on both the individual living in the nursing facility and their families. Many otherwise healthy people died from loneliness, depression and heartbreak. Personally, I have seen some elderly people that aged quicker during this time. If they had the onset of say Alzheimers, it went into overdrive during lockdowns and the disruption of the daily routine.

It is hard enough if you are cognitively in tact to live in a nursing home, but adding no visitation only compounded the difficultly and made many residents regress, and fail quicker than if they had personal, physical and psychological support and "normal" human interaction.

You had no control. The patient had no control. The pain has to be unbearable. In addition, if you were out of state or not local the ability to travel on an airplane was not easy. In NYC funeral parlors were overfilled and could not keep up with the demand for services. Bodies of loved ones sat in refrigeration trucks for months, some unidentified. 2,334 people were buried on Hart Island in 2020. In March of 2021, there were still over 700 unclaimed bodies in these trucks. I'm not sure if they were identified, but if they were not, they too were going to be buried there. I can't imagine not knowing if my loved one was in one of those trucks, waiting.

The pandemic caused over one million families loss. Whether we call it from Covid or because of Covid protocols and healthcare protocols, it really doesn't matter because at the end of the day, they lost their loved ones, and they are not coming back. Families, in many cases, were not given the opportunity to say goodbye to their loved ones. They also had no control over their loved ones suffering. Finally, many had to put off or simply not schedule funerals because of the inability to gather. If you did have a funeral, it may have been weeks after the loss of your loved one, and it was small and only immediate family. All of this goes against what we as human beings are used to. Change is never easy, but change without any say, options, or control is much worse.

Due to much of the above today, we are now paying for it in mental health. The families that experienced such losses are at high risk for prolonged grief disorder and, in some cases, PTSD. While this blog discusses the effects of Covid-19 deaths and defines the components of a "good death." and mental health, we can't forget the healthcare providers that were on the frontlines over the past two years. While they may not have experienced a loss personally, they served as the connective tissue between a family and their dying loved one in the hospital, and that alone will take its toll.

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